Captain Michelle Racicot, Army Trauma Nurse
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Racicot grew up in New Mexico, but San Antonio has been her home base since she was stationed at Fort Sam Houston in 1998. She plans to leave the Army next spring and get a graduate degree in nursing from the University of Texas at San Antonio.
My mom was an ICU nurse. After high school, I went to work as a nursing assistant with her, and I just loved it. In 1997 I joined the Army as an enlisted soldier to become a medic. The Army offered me a four-year scholarship to a private college to get my bachelor’s degree and become a registered nurse. When I came out, in 2004, I was an officer. The first place they sent me was Germany, to Landstuhl. Then I got deployed to New Orleans for Hurricane Katrina with the 21st Combat Support Hospital. A CSH is a hospital that just packs up its gear and goes. We set up at the convention center, and I worked in the emergency department. Cardiac arrests and gunshot wounds. That’s when I fell in absolute love with the ER.
When any patient comes in, the first thing I do is look at them from head to toe and say, “Are they breathing? Are they talking to me?” If they are, then I ask, “What does their color look like?” I don’t want them to be pale or ashy or cold, because that’s either blood loss or shock. It means their tank is not running so good. From there I put monitors on and try to get some IV access in case they need medications. It’s an algorithm, a step-by-step process that is the same with every patient. I think of it as chess. I always want to have everything planned four or five steps ahead.
Flexibility matters too. Last March I deployed to Afghanistan with a forward surgical team, an FST. It’s an elite team, twenty people or less, that sets up on a forward operating base far from the hospital. Two OR beds. Four trauma beds. But you don’t have nice widgets. When you’re in the middle of a sandbox, sometimes your machine has been around for forty years. Sometimes it doesn’t work and you have to be able to think around it. Our FST was in eastern Afghanistan, and it was the busiest FST in the country the last three months we were there. We saw more trauma patients than all of Iraq during those months. Fifteen patients came in just on election day.
It’s different here at Fort Sam. There I was in charge. Here I’m just another captain. I still take care of the trauma patients, but I also have surgical and medical patients, civilians from San Antonio. Here it’s chest pains or adrenal crises or diabetes, a little bit of everything. And here I get days off and can shower. I can drive a car. I don’t have to carry my weapon.
The shifts are twelve hours. I usually take four low-acuity beds and three high-acuity beds—that’s someone who needs one-on-one attention, versus someone who has a cold. We do burns for all of Texas. They can transfer any patient to us for burns. The goal in burns is speed and cleanliness. Get them into OR as soon as possible so their burns can be debrided, the dead skin taken off and the medicine put on. We also get PTSD patients. I’ve had soldiers who have gotten drunk, warriors in transition who’ve had all this traumatic experience and now they’re at that stage in life where they’re wondering what to do. They’re easier for me to deal with because I can say, “I love you as a brother, but we gotta have a come-to-Jesus meeting right here.”
I had a patient in Afghanistan who had been in a rollover and broken his foot. We needed to do a manual decompression on it and were giving him ketamine to consciously sedate him. He started crying and calling out for a friend. The guys with him said, “No, that’s the buddy that died the last time he was on patrol. He’s been having nightmares lately.” So you’re trying to take care of him, and the medicine makes him revisit traumatic events. We don’t want that. It’s my job to say, “He needs to see a psychiatrist.”
There are times when you go through a patient’s belongings and find a card that says something like “I want to die.” You have to say, “This concerns me. Do you want to hurt yourself?” They’ll say no. So you say, “Okay. But I’m still going to ask a psychologist to talk to you, because these feelings are important.” You have to say that. It’s important to feel those emotions. We’ve all been there. We all have things we dream about. PTSD is real and can come from anything. It can be that they saw a kid die. It could be having to pick up dead bodies. These soldiers don’t just see one thing. It’s everyday life for them. No one tells you that as an Army nurse you’re going to deploy and take care of little kids. They say you’ll take care of soldiers. They never told me I’d have to hold someone’s hand when they die. But I do. There’s no magical manual. You do it. And when you have bad days, you call your friends and you say, “I need love.”
I had a soldier that I took care of over there. I had seen him on the FOB and talked to him and his friends, and he’s just a funny guy. We’d roast marshmallows. And then one day he came in and almost died on us. He was a gunner on an MRAP [mine resistant ambush protected vehicle] that got hit by an IED, and he had a closed head injury. It was causing him to stop breathing and talking. So I said, “We’ve got to intubate him.” And this is a kid that calls me “Captain R” and makes fun of me when I’m outside reading a book. I know him. I know his name. This is my soldier. But you have to throw that out of your mind. Make sure you have your IVs. We gave him hypersaline to decrease the swelling on the brain. He had some bruising in his abdomen, but an FST doesn’t have a CT scan to check for internal bleeding. Usually I’d use a handheld ultrasound to check, but we didn’t even have that. So I visualized the bruising and felt the tenderness, and I improvised. I sent him into OR to check his belly. They stabilized him and sent him to the hospital at Bagram.
He lived. And he came back to BAMC [Brooke Army Medical Center] here. And when I came back, he was still here. He said, “Cool. Can we go to lunch?” So we went to lunch, and he said, “Thanks for saving my life.” That means a lot.